Consider the DRE gap: Category I assumes that people with a sprained back recover within 6 months to 1 year, justifying a 0% WPI. But the reality is that there are patients who intermittently have symptoms, such as muscle spasms, muscle guarding, decreased range of motion, etc., and their ADLs are significantly affected for many years.

Some physicians try to avoid the DRE gap by assigning a category II in such instances. As long as there is a pathophysiological explanation for the spinal symptoms, the physician may be able to justify a WPI rating.

Other physicians use the ROM method to get around the DRE gap by calling a musculoskeletal sprain or strain a "soft-tissue lesion" under AMA Guides Fifth Edition, Table 15-7, p. 404, then combining that WPI rating with the ROM rating with no ratable neurological impairments.